Slow Bleed

By Tim Adler

A missing son
A kidnapper who's dead
Nobody believes her
Nothing will stop her

When Doctor Jemma Sands' five-year-old son goes missing, only she believes
that a vengeful patient has stolen her child.

How do you convince police to search for a dead woman? As her world falls apart, Jemma realises she is the only one who can save her son.

If somebody took your only child, how far would you go to get him back?

What the critics say about SLOW BLEED:

'A tense and gripping crime read ... Slow Bleed grabs you by the throat' - Raven Crime Reads

'One of those books you can't put down ... a great medical thriller' -  Book of the Month, Crime Book Club

What the critics say about Tim Adler:

'Compulsively readable' Sunday Times Culture

***** The Daily Telegraph

'Adler writes with brio' The Week.com
 

• Language: English
• Publisher: Basket Media Ltd
• Release date: Mar 9, 2017
• ISBN: 9781911331278

Tim Adler

Tim Adler is the author of The Producers: Money, Movies and Who Really Calls the Shots and Hollywood and the Mob: Movies, Mafia, Sex and Death. He is also the editor of film trade magazine Screen Finance, described as 'highly influential' by the London Evening Standard. He has written about the movie industry for, among others, the Financial Times, the Daily Telegraph and Sunday Business.

Book preview

Books by Tim Adler

The House of Redgrave:

The Lives of a Theatrical Dynasty

Hollywood and the Mob

Slow Bleed

Surrogate

Hold Still

For Basil Phillips

Anyone who hasn't experienced the ecstasy of betrayal knows nothing of ecstasy at all.

Jean Genet, Prisoner of Love

Chapter One

Her first thought when she saw the flash was that it was the whitest white she had ever seen. Her next thought was about her son, whom she would never see. And that she was going to die.

Toppy Mrazek first sensed something was wrong when she saw both cars coming up fast in her rear-view mirror. They were racing each other, accelerating towards her in the fast lane. Instinctively, she took her foot off the accelerator and shifted in her seat in an attempt to get comfortable. The drum of her stomach was tight against the steering wheel, and she could feel her baby moving around inside her, as if somebody was pressing a thumb against her from the inside. She had cried when she first saw him turning on the ultrasound. Now, five months later, there was barely enough room for her in the sports car she had once cared so much for. The silver Mercedes suited her image as a young female executive. Her body was changing now that her baby was on the way; climbing the corporate ladder, which had once seemed so important, now appeared meaningless.

Two lads passed by in souped-up street cars. Fat exhaust pipes. She glimpsed one of them guffawing with laughter as he overtook her. She registered that the cars were far too close together and, again, it made her want to hang back.

Her heart welled at how her life was about to change, at the budding life inside her. Single life – which for Toppy consisted of working long hours as an office manager in the City and then coming home to a microwave dinner in an empty flat – had palled. She had longed for a baby, something that would give her life meaning, for years now. Her heart had dropped every time she opened a We're pregnant! email at work. It physically hurt her. Right where a baby would grow. Soon there would be two of them – it amused her to think that, eight hours away in Hong Kong, her son's father was blithely unaware of the changes going on inside her. Not that he would ever know. She had decided it was going to be just the two of them: her and her baby. She was tired of waiting for the right man to come along and marry her; she pictured her and her child living in a remote cottage somewhere in a wood. No one else. Rain pattering on the leaves as she watched him playing with his wooden blocks on the floor.

Toppy's thoughts were interrupted by the sight of both cars dropping into her lane, right in front of her. She slammed on the brakes, stopping just short of the Honda. It swung out again, trying to get ahead of the Renault. It was such a dangerous manoeuvre that she wondered whether the boy behind the wheel was drunk. His car howled ahead. Even with the motorway noise, you could hear the boom of his exhaust.

Something was wrong. The Honda started weaving, and, to Toppy's horror, it slewed and bumped the weed-choked central reservation, touching the crash barrier at more than one hundred miles an hour. Bits of plastic and metal spewed out of its back and tumbled towards her. The Honda touched the railing again, and this time it hurdled the fast lane, spinning round and around directly in front of her.

Everything went into slow motion; it was as if time had elongated. She pulled the steering wheel down, trying to swerve, and must have clipped the Honda, because the next thing she knew, her world windmilled upside down, and she was thrown onto the motorway. She knew what was about to happen. The road was coming up fast. She closed her eyes and braced herself for impact. There was a juddering crunch as the world collapsed around her. Flipped upside-down, she felt her car scraping along the road.

Toppy opened her eyes only when it had come to a stop. She was still gripping the steering wheel. The smell of petrol and burnt rubber was in the air, and the hot metal of the car ticked softly. She let go. Toppy was hanging from the driver's seat with her head jammed against the roof. Through the windscreen, she was facing the car she had just swerved to avoid. Ugly skid marks slalomed across the fast lane. Smoke was rising from the Honda's engine, and curious people were already getting out of the cars queuing behind it.

Her first thought was for the tiny baby inside her. Was he all right? She couldn't feel him moving.

Petrol was raining onto the windscreen, but all she could do was hang there, wedged in, suspended, unable to move. Her neck really hurt. Fighting rising panic, she groped for the safety belt but couldn't quite reach it. She felt too stunned to cry. She was still alive, and that was all that mattered.

Can you hear me?

A man appeared at the left passenger window. She nodded. He tried the door, but it wouldn't budge – the partially collapsed roof had jammed it.

Are you hurt? Can you move? I am going to get you out of there, luv, all right?

I can't breathe.

That's okay. I'm going to get you out. There's fuel everywhere. We need to get you out straight away.

The man crawled in and started trying to free her, reaching across and unbuckling her safety belt. It wouldn't open. He began tugging at the belt, as if his strength was any match for twisted steel. She started to cry once she realised what was happening. She was sitting in a petrol bomb. The car could go up at any second.

The first contraction hit. It was so painful she felt as if she was being split in two.

Ohmygod, ohmygod, ohmygod.

Look at me. Everything is going to be all right. I'm going to get you out of here.

Her guts twisted inside as another contraction hit. He didn't understand. She was going into labour. She was going to have her baby in this car.

I'm going to have a baby. Right now.

This time she screamed until she thought her throat would bleed.

The contraction ebbed away. Her vision cleared, and she found herself looking into a calm, kindly face. Behind him, flames belched downward out of the wrecked Honda's bonnet. She noticed, in a detached sort of way, that petrol was pooling towards them, snaking along the oil-stained tarmac. The man turned, realised what was happening, and started pulling frantically at her belt. The bed of fuel ignited. A wall of flame shot up, engulfing the bonnet. At that moment, the safety belt released, and Toppy fell forward out of her seat. Her saviour dragged her out of the passenger window on her belly, scraping her along the tarmac and broken glass. Please be careful of my baby, she thought. A siren rang out in the distance.

Her rescuer pulled her to her feet, just as the petrol tank exploded. Her world turned silent. The blast threw her against the man, rattling her teeth as the tarmac shook beneath their feet. The sound came back with the dull crump of the explosion. A wave of heat like a blast-furnace door being opened fell across them, and she could feel the hairs on the back of her neck singeing.

Other arms were around her now, pulling her away from the burning wreck. Another contraction twisted her guts as somebody threw a blanket over her shoulders. She couldn't believe something could hurt this much, and she started to howl with everything she had. The contractions were getting stronger now. Jesus Christ, she's going into labour, a woman said. Toppy sobbed hysterically against her rescuer's chest as firm hands steered her away. Smoke was everywhere. Toppy whimpered as they led her hobbling towards an ambulance. It's okay, it's okay, the ambulance woman kept saying. But it wasn't okay. In fact, nothing would ever be okay again.

Chapter Two

It felt like the last good day of summer, so lovely that it caught the back of your throat. Yet it was with a pang, because she knew there wouldn't be another day of such unsurpassed loveliness for another year. As she lay there gazing up at the leaves of the plane tree, Jemma reached for her husband's hand. The leaves broke up the sunlight, and she realised this was an epiphany, a moment of pure happiness. It was Saturday. They had gone to the park and taken a picnic rug and a rucksack of their five-year-old son's toys. It was such a fine afternoon that they both just lay there while the boy was off somewhere in the children's playground. Jemma watched the tree's leaves stirring in infinite perspective. Around them you could hear children shouting and the thud of a football being kicked around. Parents calling their kids. A typical London weekend afternoon.

He has got to be joking, said her husband shaking his newspaper.

Who's that? Jemma said, rolling over.

That smug, self-satisfied public-school idiot. The health secretary. He's always got this wide-eyed, how-could-this-possibly-be-happening-to-me-I-went-to-public-school look on his face. You know I met him once. At an NHS conference. You could tell he was pretty dim, that he didn't really understand what was going on. He just kept banging on about how hospitals have to be market facing.

What's he done now to get you so riled up?

He's now saying that the NHS has a lot to learn from the American health care system. Yeah, right. I remember the manager of a big Chicago hospital telling me that the moment one of the big US contractors got involved in the day-to-day running of his hospital was the death knell. Death by a thousand cuts. First, they could use only generic drugs. There was this constant pressure to upsell every operation. So you went in for a hernia and walked out with a nose job. Eventually, he said, they'd cut out every part of the hospital for themselves apart from A&E – and even that was sponsored by a liquor company. Which was ironic, since most people were in there because of booze. By the end they had hacked out every profit-making bit of the hospital and there was nothing left. The patient was dead on the table.

Tony, she said. Remember what we said? No shoptalk at weekends.

She and Tony, her husband, both worked for the same big London NHS hospital. That was where they had met. Tony had been brought in as a management consultant, while she was a house officer, the bottom rung of the surgical ladder. Like a lot of couples, they had met at a party. Two years later they had married, and their son, Matthew, was born a couple of years after that.

I mean, he's got brown fingers. Everything he touches turns to shit. Yet he keeps being promoted. I just don't get it.

Jemma cupped her head and thought how tired her husband looked. This was the first Saturday they had spent together in weeks. The NHS budget was being squeezed, and their hospital was feeling the pain along with everybody else. You noticed small things first. Blown light bulbs not being replaced. Equipment looking out of date. A creeping sense of slovenliness. Last week Jemma had seen a cockroach scuttling along an A&E corridor. She knew Tony felt as badly about it as she did. He was trying to keep the entire hospital together on less and less money. She reached up and touched his hair. The words of an old song, Together Alone, came back to her: that's how she thought of them sometimes, the two of them lying here clinging together, while the farther away they moved from this spot, the more hostile the world became.

Mummy. Push me, Matthew called out from the swings.

I'll go and get him. You stay here, Jemma said, getting up.

What are we going to do about lunch?

There are some bits in the fridge that need eating up.

Jemma walked over to where Matthew was sitting on the swing. Other fathers were pushing their children with one hand, some of them furtively checking their mobile phones. She felt a twinge of resentment at how the division of childcare had worked out. It always seemed to be her who looked after Matthew. She remembered one bitterly cold afternoon when it had just been the two of them in the park; Tony was always working. He rarely got home before nine o'clock.

She started pushing Matthew, and he laughed as he kicked his legs out. Higher, Mummy, higher, he called.

Jemma felt her mobile vibrating with a sinking feeling. She fished it out of her pocket, hoping it was her mother calling. Instead, it was a text message:

Urgent. M25 car crash. Woman in labour. Ambulance on way.

It meant going into hospital. She was on call that weekend, so her family time was over. She wasn't even supposed to be working; she had volunteered to cover for a colleague whose sister was getting married. Jemma slowed the swing down to a stop and Matthew jumped down, running off towards the roundabout. Keeping one eye on him, she called the number she had just been texted from. Jemma spoke to Guaram Chandra, her obstetric registrar. Guaram was on secondment from a big Mumbai hospital that handled just obstetrics. Soon these new super-hospitals that specialised in heart surgery or cancer treatment would be coming here too. Guaram had a slightly pompous way of talking, as if he was her superior rather than the other way round. Or perhaps he just didn't like women.

Hi, Guaram, what's up?

We've got a 33-year-old woman who's been in a motorway accident. She's going into labour. Paramedics say she's just in her third trimester. Her blood pressure is dropping and her heart rate's high.

How far apart are the contractions?

Every few minutes. She heard him say something on the other line. She's also got a fractured hip.

Okay, I'll be straight in. Oh, you'd better call the ortho registrar. Get Frank in to deal with the hip fracture.

Do you want Doctor McCracken as well?

Duncan McCracken was the consultant anaesthetist she sometimes worked with. Usually a registrar, one down from a consultant, would be fine for a woman giving birth, but this case sounded fraught with complications.

Yes. I'll meet you in A&E. I'll be in as fast as I can.

Jemma rang off and couldn't help cursing her luck. Her one day off.

Putting her phone back in her jeans pocket, she fluttered with panic when she couldn't see Matthew. Then she spotted him. There was a wooden train he liked to hide in. Soon he would realise that when Mummy's phone went, that meant playtime was over.

Matthew. Come on. We're going, she called. He deliberately ignored her. She pushed her hair away from her eyes, feeling anxiety building in her stomach. This was going to make her late. But how do you explain what a surgeon does to a five-year-old boy? She walked over to the train and found her son hiding in one of the dark windowless carriages. He was laughing. She caught his wrist a little more firmly than she intended and he yelped. Then he started to wail. Jemma felt another mother looking at her disapprovingly. Come on, Matthew, I haven't got time for this, she said loudly, partly for the other mother's benefit. Mummy's got to go to the hospital.

Dragging her straining, protesting son back to where Tony was still lying down, she said: The hospital called. I've got to go in. There's been a car crash, and a woman's going into labour.

Tony put down his paper and said, Oh God, I am sorry, love. Don't worry about us, we'll be fine. We can go and get something to eat at the café. Would you like that, Matthew?

Ice cream, said Matthew solemnly.

No ice cream, said Jemma, packing up her things from the picnic rug.

What time will you be back? Remember, we've got Emily and Adam coming round for drinks tonight.

Jemma raised her eyes. Oh, I forgot. I'll pop in on my way home and tell them that I'm going to be late. I'll pick up something to shove in the oven. You can get started without me.

Her voice had an edge in it she hadn't quite intended. Tony raised his hands as if to say there was no problem. She leant down and kissed him, her mind already going through what she had to do next: if there was internal bleeding, the quickest thing would be to perform an emergency caesarean. The road crash victim wouldn't be able to push with a fractured hip. If the mother's vital signs were dropping, she would have to get the baby out quickly.

Jemma was still running through her options by the time she arrived at the house next door. Their neighbours were an insurance broker and his wife. The two couples had become friendly over the summer, occasionally sharing meals in their back gardens. Emily, the wife, had a three-year-old and a newborn. She would spend those summer evenings looking anxiously at the baby monitor strapped to her waist. Adam, her husband, was nice if a bit dull, and Jemma sensed that Tony was always a little patronising towards him.

Unlike the Sands, they were renting. Very few people who worked at the hospital could afford to live locally. Jemma knocked and Emily opened her front door, grinning broadly. She always seemed so pleased to see her. There was something inside her that was genuinely good and that Jemma responded to. How much more interesting were the subtle varieties of good compared with the banality of evil.

Emily, I'm really sorry, but I've got to go in to the hospital. I won't be back until later.

Oh, that's absolutely fine. Don't worry. Why don't we do it another time?

I'm not saying that. Tony's in the park with Matthew. Why don't you come round at six, and I'll try and make it back when I can.

Inside, Jemma glimpsed the happy chaos of family life. Emily's naked three-year-old daughter ran up and hugged her mother's leg, gazing shyly up at the visitor. Her next-door neighbour had a relaxed attitude towards parenting that Jemma admired but could not quite share. Emily once told her that coming to their house felt like walking into an operating theatre, with toothbrushes and toothpaste lined up in the bathroom like surgical instruments. Never a toy left out or anything out of place.

Only if you're absolutely sure, continued Emily. We'll stay for one drink and then it'll be bath time.

Yes, please do, said Jemma quickly. She glanced at her watch. It was 1:26pm and she was late. She pictured the ambulance with its blues and twos on, hammering up the Fulham Road.

Jemma let herself in through her front door and dumped her rucksack on the kitchen counter, grabbing her car keys and shoulder bag. She would have to hurry. It was now 1:40pm.

Their car was parked in the doctors' reserved bay in front of their house. Jemma tried ringing Guaram again, but the call went straight through to voicemail. Tossing the mobile onto the passenger seat, she started the engine, which bobbled reassuringly. She knew their green Subaru was slightly vulgar, but she liked the punch of the acceleration. Their London terraced street quickly became a blur as she put her foot down.

Traffic was nearly at a standstill along the Fulham Road, though. Cars were crawling along. She imagined the swing doors banging open as the car-crash victim was pushed into theatre, her saline drip jangling as Guaram got her prepped. Up ahead, four policemen swayed on horseback wearing hi-vis jackets. The horses had fluorescent quarter sheets on. Of course, Saturday afternoon. There was a football match. Chelsea were playing at home. 1:44pm. Jemma hadn't counted on this. Fat men wearing clinging soccer shirts walked three abreast along the pavement, and she felt her impatience rising as she glanced at the digital clock. 1:46pm. Traffic was being diverted. She contemplated abandoning the car, getting out and running, when the car in front edged forward. The farther they got from the stadium, the more traffic eased up.

Eventually Jemma turned right and pulled into the hospital's underground car park. The back bumper dipped as the car dropped down the ramp. There was a screech of tyres as she searched for a reserved parking space. The car park had a hot rubbery smell, and she glanced down at her BlackBerry, blinking like an angry red mosquito. There was another text message from Guaram: Urgent. Patient crashing.

Chapter Three

Jemma nodded to the nurse on duty behind the Plexiglas window as she hurried into A&E. The public benches resembled a war zone. Drunks sat watching television with cans of Special Brew pushed discreetly behind their chair legs. She keyed in the numeric door code. The A&E receptionist told her that the car-crash victim was in the third cubicle on the left, and she hurried past a man clutching his bandaged head.

Jemma pulled the curtain back and saw Guaram and the consultant anaesthetist standing over the woman who had been brought in. She was hooked up to the ECG and a blood pressure monitor. Pop… Pop… Pop… Her heart rate was slowing. Blue digital numerals showed her blood pressure was dropping too. My baby, my baby, she moaned, before screaming as if her guts were being wrenched. Jemma could see she was going into hemodynamic shock.

How many weeks pregnant? Jemma asked.

I am guessing around thirty weeks, Guaram said.

We need to get her into theatre as soon as possible, said McCracken. Her blood pressure is ninety over forty and dropping.

What's her heart rate?

It's dropped to fifty. Everything's collapsing.

She glanced quickly at the woman's notes: Toppy Mrazek, age 33. Road traffic accident. Asthma.

Jemma said briskly, My name is Doctor Sands. Your baby wants to come out now, do you understand? I am going to deliver your baby. Is it all right if I touch you? My fingers might feel cold.

The woman groaned and nodded. Jemma pulled up the car-crash victim's dress. The moment her fingers touched the patient's abdomen, she had a strange premonition that she was going to come into great conflict with this woman. Stop being so ridiculous, she thought, what an absurd thing to think. She had work to do. The woman's trunk was growing in size before her eyes and it was tense to the touch – a sure sign of serious intra-abdominal bleeding. She guessed the patient was exactly thirty-two weeks pregnant. She knew she had to save the mother and the baby. Both of them were her patients, although the mother took priority. This was not going to be easy, but she would do it; she had spent seven years of her life training for emergencies like this.

She squirted some ultrasound gel onto her palm and rubbed it on the woman's belly. Using the foetal Doppler, she listened for the baby's heart rate. The heartbeat was erratic and faint. The baby was in distress, and she had to get it out as fast as possible. Only then could she try to save the woman's life.

Together the three of them pushed the woman down the corridor towards the theatre. Toppy Mrazek howled as another contraction hit. Her baby was moving into position. They had to get it out now. Banging the doors open with the trolley, the scrub nurses raced to get her prepped while Jemma changed.

The women's changing room was empty. Jemma grabbed a set of blue pyjamas and undressed as quickly as she could. The starchy top and bottoms brushed against her skin and underwear. Pulling a dirty-looking pair of white clogs from the rack, she slipped the sky-blue disposable cap over her head. From here it was only a short jog to the sterile theatre changing room. She clacked down the corridor where they would be waiting for her. It was 2:29pm.

Inside the scrub room, she slapped the disposable gown pack onto the counter. Opening it up, she breathed in the oddly industrial smell. Turning on a pair of long-armed taps, she wet her hands, pressing the Betadine dispenser with her elbow. In her head, she pictured what she was about to do. She tried telling herself there was nothing to worry about, that it was an operation she had done many times before, but for some reason her heart was racing. Raising her hands in the air, she felt rivulets of sweat running uncomfortably down her arms.

Somebody came in behind her. She's just gone under, said Rose, a theatre nurse. Could you give me a hand? Jemma asked. She tied both ribbons of the mask behind her head, squidging the strip over her nose until the mask fit snugly on her face. Rose fastened the ties down her back. Hurry, hurry, they had to hurry.

She backed into theatre with her arms crossed over her chest like a high priestess with the scrubs nurses as her acolytes. Usually operating theatres were calm places; Jemma found them almost restful. The last thing you wanted in theatre was drama. That was partly why she became a surgeon; it appealed to her sense of order. However chaotic the world outside might be, nothing unexpected could happen here. Today, however, felt different. The air seemed stiff with tension.

The patient's chest was exposed under the harsh overhead light. Even like this, unconscious with a ventilator tube in her trachea, the woman was still beautiful. She was just the type that Tony would go for, Jemma thought. She knew that she was the exception when it came to the sort of woman Tony preferred. She was blonde for a start. Straightforward. Athletic. Tony had joked that all his previous girlfriends had been neurotic brunettes with a death wish. A few strands of hot brown hair peeked out from beneath the car-crash victim's surgical cap, and something made Jemma want to tidy them up and tuck the hair back under.

Whenever you're ready, Doctor, said Guaram.

The radio was playing a jaunty pop song, and Jemma asked for it to be turned off. Now she could hear the pop, pop, popping from the heart-rate monitor. It wasn't loud, but it dominated the room like a metronome. The blips were getting farther apart. She imagined the baby struggling for life.

The baby's heart rate is crashing, said McCracken. It's going into shock.

Doctor Sands, you'll lose the baby if you try and do a C-section now, Guaram said. Better wait until she's stabilised.

That will be too late, Jemma said. She'll die if we don't get the baby out.

But the baby isn't viable. We need to get its vital signs back up.

She saw panic in his soft brown eyes. Guaram didn't know what he was talking about, she decided.

Calmly, she swabbed the woman's stomach with iodine. Her scalpel rested just below the woman's belly button. There was a moment of resistance before the flesh gave way and she swept the scalpel down in a vertical uterine incision, working quickly through the first layers of fat and tissue. Guaram cauterised. There was a smidge of smoke and a burnt-flesh smell every time his wand touched the woman. Jemma began separating her abdominal muscles by hand, revealing the uterus. One more layer to go. There. They were through. She started pulling the baby out, cradling his precious head and scrawny, hunched-over purple-red body. Where was the noise, where was the indignant yelling? This baby was not even trembling with shock.

Flatline. She was too late.

The baby was dead.

Rose began suctioning his nose and mouth, but Jemma knew it was useless. This baby was stillborn.

She could not believe what had just happened.

The baby should have been fine, even if his vital signs were dropping. She had done everything by the book. This had never happened to her before. She cut the tough umbilical cord while a neonatal nurse waited to take the baby from her. Although Jemma knew it was hopeless, the neonatal nurse would still try and revive him.

It was only now that Jemma realised the trouble she was in. The woman's uterus was filling up with blood as quickly as a basin fills with water. Blood was rising up over the sides of the incision, pooling around Jemma's hands, with some of it spilling